Living Drugs in Action: Transformative Advances in CAR-T Cell Immunotherapy

Chimeric Antigen Receptor (CAR) T cell therapy represents a paradigm shift in oncology, transitioning from traditional non-living pharmacological agents to living drugs that employ engineered immune cells to target cancer cells with more precision and adaptability. As living therapies, CAR-T cells can expand, persist, and evolve within the patient, offering a level of durability and dynamic tumor engagement unmatched by conventional treatments. This innovative therapeutic approach has redefined outcomes for patients with relapsed or refractory hematologic malignancies, offering durable remissions in settings historically associated with poor prognosis and limited therapeutic success. Building on its success in blood cancers, the CAR-T field is now entering a new phase of innovation, with investigators rapidly developing next-generation constructs, enhancing safety through more innovative design, and expanding the application into solid tumors and autoimmune diseases. However, significant challenges, including antigen escape, treatment-associated toxicities, manufacturing issues, and limited global access, continue to shape research priorities and the clinical translation of these therapies. In this npj Precision Oncology Collection, Living Drugs in Action, we aim to highlight the evolving scientific and clinical advances that are propelling CAR-T therapy into the new era of cancer therapeutics. We invite researchers, clinicians, and translational scientists to submit high-impact original research, mechanistic and translational studies, and expert perspectives that address the key challenges and evolving opportunities in this field.

We invite submissions, but are not restricted to the following areas:

• Next-generation CAR-T cell design
• Non-viral CAR-T engineering
• Clinical trial advances
• Biomarker discovery and validation
• Translational and preclinical models
• Mechanisms of resistance and relapse
• Toxicity mitigation and safety engineering
• Combination therapies
• Beyond hematologic malignancies
• Enabling platforms and technologies
• Manufacturing, scalability, and regulatory science
• Ethical, societal, and access considerations